Voice prosthesis leakage: Tips for effective management and care
How to check if your voice prosthesis is leaking and how to reduce and prevent leakage.
Introduction
A voice prosthesis is a device that needs proper care and maintenance. We’ve put together this helpful guide so that you can quickly and easily identify leakage and take the necessary steps to resolve and prevent the issue.
A voice prosthesis at a glance
A voice prosthesis is a small device made primarily of medical grade silicone. The prosthesis is placed between the food pipe (esophagus) and windpipe (trachea) and has two ‘collars’ on either side to keep it in place. Between these collars, there is a smaller tube that contains a one-way valve. This valve opens while speaking and is closed when eating or breathing to prevent anything from entering the windpipe that shouldn’t – such as saliva, food or liquid.
Provox voice prostheses are manufactured with high precision at the Atos Medical production plant in Sweden. Each voice prosthesis is thoroughly inspected by specially trained personnel before being approved and delivered to you.
Why does a voice prosthesis leak?
In time, all voice prostheses will start to leak due to a variety of reasons. The most common reason is fungus, yeast and bacteria, otherwise known as biofilm. This biofilm may attach to the voice prosthesis, preventing the valve from closing properly.1,2 Bacteria and fungi are naturally present in the mouths and throats of all people, and the accumulation will in time happen on all prostheses.1,2 Leaking can also be caused by food that has been caught in the voice prosthesis and is preventing the valve from closing properly or for other reasons that your clinician can help you to identify.
Types of voice prosthesis leakage
Leakage of fluids or food into the windpipe is the most common problem related to the use of a voice prosthesis3. The leakage can come through the small opening in the centre of the voice prosthesis, or around the outside of the prosthesis, seeping between the collars and the tissue. Leakage through and leakage around the prosthesis are solved in different ways, so it is important to determine how the prosthesis is leaking.4,5 Contact your clinician to learn more about how to check for leakage when you are at home.
Typical signs of voice prosthesis leakage are:
- Coughing during, or after, eating and drinking
- Fluid-stained mucus
- Food-stained mucus
- Increased mucus
- Recurrent chest infections
Voice prosthesis leakage test:
We’ve put together a helpful guide to help you test if your voice prosthesis is leaking. We recommend that you test for leakage at least once a month. For additional support please see our CareTip here.
- Stand in front of a mirror with good light and clean your Provox voice prosthesis with a Provox Brush and Provox Flush
- Take a sip of coloured liquid (e.g., milk, coffee or juice, as they are easier to see)
- See if any liquid leaks through or around your voice prosthesis. If you need help, ask someone to look for you. You may need to take another sip to check again
- If you are not sure if it is leaking through or around the voice prosthesis, insert the Plug into the voice prosthesis and take another sip. If it still leaks, it is most likely leakage around the voice prosthesis. If there are no more signs of leakage, it is most likely leakage through
- If you are experiencing leakage that does not resolve by cleaning the prosthesis, contact your clinician for a voice prosthesis change
Did you know?
Leakage can, if not solved, may cause chest infections. Fluids or food could enter the trachea (windpipe) and lungs, leading to increased mucus production and coughing, and may also lead to infections and, in rare cases, pneumonia.5,7,8
Tips for managing a leaking voice prosthesis
Consider thickening your liquids to decrease or eliminate leakage or try to avoid thin liquids such as water and coffee. Commercially available thickeners can be added to most liquids to make them thicker. Contact your clinician for advice on what thickeners may be right for you.9
Clean your voice prosthesis at least two times per day, in the morning and in the evening, and after each meal.9
When you have a Provox plug in place you will not be able to speak with your voice prosthesis. You could consider using an electrolarynx during those times. Your clinician can advise you about this.9
Always read the Instructions for use before starting to use any of the products. For Instructions for use, please visit www.atosmedical.us.
Voice prosthesis dislodgement
On very rare occasions, a voice prosthesis can dislodge or come out accidentally. Make sure you have spoken to your clinician and have a plan in case this occurs. Atos Medical has a CareTip where you can log the plan identified by you and your clinician.
view caretipsReferences:
1 Spalek J, Deptula P, Ciesluk M, Strzelecka A, Lysik D, Mystkowska J, et al. Biofilm Growth Causes Damage to Silicone Voice Prostheses in Patients after Surgical Treatment of Locally Advanced Laryngeal Cancer. Pathogens. 2020;9(10).
2 Leonhard M, Zatorska B, Tan Y, Moser D, Schneider-Stickler B. In vitro biofilm growth on modern voice prostheses. Head Neck. 2017;40(4):763-9.
3 Graville DJ, Palmer AD, Andersen PE, Cohen JI. Determining the efficacy and cost-effectiveness of the ActiValve: results of a long-term prospective trial. Laryngoscope. 2011;121(4):769-76.
4 Parrilla C, Longobardi Y, Galli J, Rigante M, Paludetti G, Bussu F, et al. Periprosthetic Leakage in Tracheoesophageal Prosthesis: Proposal of a Standardized Therapeutic Algorithm. Otolaryngol Head Neck Surg. 2021:194599820983343.
5 Lorenz KJ. The development and treatment of periprosthetic leakage after prosthetic voice restoration. A literature review and personal experience part I: the development of periprosthetic leakage. Eur Arch Otorhinolaryngol. 2015;272(3):641-59.
6 Acton LM, Ross DA, Sasaki CT, Leder SB. Investigation of tracheoesophageal voice prosthesis leakage patterns: patient's self-report versus clinician's confirmation. Head Neck. 2008;30(5):618-21.
7 Kummer P, Chahoud M, Schuster M, Eysholdt U, Rosanowski F. [Prosthetic voice rehabilitation after laryngectomy. Failures and complications after previous radiation therapy] in German. HNO. 2006;54(4):315-22.
8 Scherl C, Kauffels J, Schutzenberger A, Dollinger M, Bohr C, Durr S, et al. Secondary Tracheoesophageal Puncture After Laryngectomy Increases Complications With Shunt and Voice Prosthesis. Laryngoscope. 2020.
9 Atos Medical. What to do if your voice prosthesis is leaking?; 2024 [cited 2024.04.24]. Available from: https://www.atosmedical.com/news/what-to-do-if-your-voice-prosthesis-is-leaking
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